SOFT TISSUE BIOMECHANICAL BEHAVIOR DURING ACUPUNTURE IN LOW BACK PAIN

针灸治疗腰痛时软组织的生物力学行为

• 批准号: 8166971
• 负责人: HELENE M LANGEVIN
• 金额: $ 5.22万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-03-01 至 2011-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8166971
• 关键词: Acupuncture Points; Acupuncture Therapy; Acupuncture procedure; Alternative Medicine; Architecture; Area; Articular Range of Motion; Back; Behavior; Biological; Biomechanics; Biopsy; Bladder; Chronic low back pain; Clinical; Clinical Trials; Clinical assessments; Collagen; Computer Retrieval of Information on Scientific Projects Database; Connective Tissue; Coupling; Data; Deposition; Disease; Engineering; Functional disorder; Funding; Future; Gallbladder; Grant; Human; Imagery; Individual; Institution; Intramuscular; Lead; Leg; Length; Location; Low Back Pain; Manuals; Measurement; Measures; Meridians; Modeling; Motion; Muscle; Nature; Needles; Orthopedics; Outcome Measure; Pain; Palpation; Patients; Pattern; Performance; Physical therapy; Physics; Play; Process; Property; Rehabilitation therapy; Research; Research Personnel; Resources; Role; Rotation; Series; Source; Techniques; Testing; Therapeutic; Thick; Time; Tissues; Torque; Ultrasonography; United States National Institutes of Health; Water; base; human subject; in vivo; insight; kinematics; multidisciplinary; primary outcome; response; soft tissue; subcutaneous; theories; trial comparing

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The principal aim of this proposal is to test the hypothesis that individuals with chronic low back pain (LBP) have altered soft tissue biomechanical behavior during acupuncture needling in the lower back and legs compared with individuals without LBP (No-LBP). We will also test whether or not altered tissue behavior in LBP is generalized, or localized to specific locations as predicted by traditional acupuncture theory. This proposal constitutes the first step to testing the mechanistic model that 1) altered soft tissue biomechanical behavior during needling in LBP is due to abnormalities of connective tissue (subcutaneous, perimuscular and/or intramuscular), 2) connective tissue plays an important role in both the therapeutic mechanism of acupuncture and the pathophysiological mechanism of LBP, and 3) these two mechanisms are related. Acupuncturists describe qualitatively different needling responses at locations believed to be "involved" in the patient's disease process. Although assessing abnormalities in the needling response is a fundamental aspect of acupuncture therapy, what constitutes a normal vs. abnormal needling response has never been studied quantitatively. Thus the nature of tissue changes underlying these phenomena remains unknown. We have recently developed a new in vivo technique based on ultrasound elastography in humans that allows visualization and quantification of tissue displacement and strain patterns developed in tissues during needle manipulation (65). In this proposal, we will use ultrasound elastography to perform measurement and detailed analysis of tissue biomechanical behavior during needling in human subjects with and without LBP. AIM 1: Examine tissue biomechanical behavior during acupuncture in LBP vs. No-LBP: 80 subjects with LBP and 80 control subjects without LBP will be tested. We will test acupuncture points (APs) and non-acupuncture points (Non-APs) on the Bladder (BL) and Gall Bladder (GB) meridians as well as Non-Meridian Non-APs in the back and leg. Primary outcome measures will be: 1) peak torque during needle rotation (Torque); 2) needle force decay rate during needle oscillation (Force decay); 3) tissue displacement (Displacement) in Subcutaneous, Perimuscular and Muscle zones during needle oscillation; 4) Perimuscular zone thickness (Thickness). Our preliminary data suggest that tissue behavior during needling in the lower back is abnormal in LBP. We hypothesize that Torque and Displacement are smaller and that Force decay and Thickness are greater 1) in LBP than in No-LBP, 2) at Meridians than at Non-Meridians, 3) at APs than at Non-APs, 4) in the back than in the leg. In LBP subjects, we will also examine the relationship between these outcome measures and 1) subjective pain pattern, 2) tenderness to palpation. AIM 2: Quantify tissue material properties responsible for biomechanical behavior observed in Aim 1: Data from Aim 1 will be used to develop, evaluate and implement a biomechanical model to quantify parameters including stiffness, damping and needle/tissue coupling time constant associated with each of three tissue zones (Subcutaneous, Perimuscular and Muscle). We hypothesize that stiffness is greater and that damping and needle/tissue coupling constant are smaller in LBP compared with No-LBP. These parameters also will be used to generate further hypotheses regarding connective tissue pathophysiological mechanisms potentially responsible for abnormal soft tissue behavior in LBP (e.g. increased or decreased tissue water content, abnormal connective tissue matrix architecture, increased or decreased collagen deposition). These hypotheses will be tested in future studies that will combine ultrasound elastography and tissue biopsies in LBP and No-LBP. AIM 3: Examine the relationship between tissue behavior during acupuncture and clinical assessment prior to needling: In all subjects tested in Aim 1, we will perform clinical measures of muscle length in areas that will be needled as well as range of motion (ROM) and functional assessments. These measurements will be compared with parameters calculated in Aim 2. We hypothesize that stiffness will be negatively correlated, and that damping and tissue coupling constants will be positively correlated with muscle length and ROM in corresponding muscle groups as well as physical performance measures. These data will pave the way for a future clinical trial comparing the effects of acupuncture and physical therapy using both subjective (pain reduction, functional assessment) and objective outcome measures (ultrasound elastography, bulk passive tissue stiffness, kinematic motion analysis and muscle activity) both before and after a series of treatments. This multidisciplinary study bridging the fields of alternative medicine, physical therapy, engineering, physics and orthopaedics will provide objective biomechanical measurements of phenomena fundamental to acupuncture. This study also may 1) lead to important new insights on the pathophysiology of LBP and 2) provide objective biological outcome measures for future clinical trials of acupuncture and other "alternative" manual therapies as well as physical and rehabilitation therapy.

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 这项建议的主要目的是检验一种假设，即与没有慢性下腰痛(LBP)的人(无LBP)相比，慢性下腰痛(LBP)患者在针刺腰部和腿部时改变了软组织生物力学行为。我们还将测试LBP中改变的组织行为是否如传统针灸理论所预测的那样是泛化的，还是局限于特定位置的。这一建议是验证以下机制模型的第一步：1)LBP针刺过程中软组织生物力学行为的改变是由于结缔组织(皮下、肌周和/或肌肉内)的异常所致；2)结缔组织在针刺的治疗机制和LBP的病理生理机制中都起着重要的作用；3)这两种机制是相关的。 针灸医生描述了不同的针刺反应，在据信与患者的疾病过程有关的位置。尽管评估针刺反应的异常是针灸治疗的一个基本方面，但什么构成正常的针刺反应和异常的针刺反应从来没有被定量研究过。因此，这些现象背后的组织变化的本质仍然未知。我们最近开发了一种基于人体超声弹性成像的新体内技术，可以可视化和量化在针操作过程中在组织中形成的组织位移和应变模式(65)。在这项建议中，我们将使用超声弹性成像来测量和详细分析在有和没有LBP的人体受试者针刺过程中的组织生物力学行为。 目的1：检测LBP与非LBP在针刺过程中的组织生物力学行为：对80例有LBP和80例无LBP的对照组进行测试。我们将测试穴位(AP)和非穴位(Non-APs)对膀胱(BL)和胆经(GB)经络的影响，以及背部和腿部的非经脉非APs。主要观察指标为：1)针头旋转时的峰值扭矩(扭矩)；2)针头摆动时的针力衰减率(力衰减)；3)针头摆动时皮下、周围和肌肉区域的组织位移(位移)；4)针头周围区域的厚度(厚度)。我们的初步数据表明，LBP患者下背部针刺时的组织行为异常。我们假设扭矩和位移更小，力衰减和厚度更大1)LBP比无LBP，2)经络比非经络，3)AP比非AP，4)背部比腿。在LBP受试者中，我们还将检查这些结果指标与1)主观疼痛模式、2)触诊触痛之间的关系。 目标2：量化目标1中观察到的生物力学行为的组织材料属性：目标1的数据将用于开发、评估和实施生物力学模型，以量化与三个组织区域(皮下、肌周和肌肉)相关的参数，包括硬度、阻尼和针/组织耦合时间常数。我们假设，与非LBP相比，LBP的刚度更大，而阻尼器和针/组织的耦合常数更小。这些参数也将被用来产生关于结缔组织病理生理机制的进一步假说，这些机制可能导致LBP的异常软组织行为(例如，组织水分含量增加或减少，结缔组织基质结构异常，胶原沉积增加或减少)。这些假说将在未来的研究中得到验证，这些研究将结合超声弹性成像和组织活检在LBP和No-LBP中进行。 目的3：研究针刺过程中的组织行为与针刺前临床评估的关系：在目标1中测试的所有受试者中，我们将对将被针刺的区域的肌肉长度进行临床测量，以及活动范围(ROM)和功能评估。这些测量值将与目标2中计算的参数进行比较。我们假设僵硬将是负相关的，而阻尼和组织耦合常数将与相应肌肉组中的肌肉长度和活动度以及身体表现指标正相关。这些数据将为未来的临床试验铺平道路，该试验在一系列治疗前后使用主观(止痛、功能评估)和客观结果测量(超声弹性成像、全身被动组织僵硬、运动分析和肌肉活动)来比较针灸和物理治疗的效果。 这项跨越替代医学、物理治疗、工程学、物理学和骨科领域的多学科研究将为针灸的基本现象提供客观的生物力学测量。这项研究还可能1)为LBP的病理生理学提供重要的新见解，2)为未来针灸和其他“替代”手法治疗以及物理和康复治疗的临床试验提供客观的生物学结果指标。